Metalloproteinases as a prognostic factor for early postoperative period in patients with blunt splenic injuries

Objective: to evaluate the levels of metalloproteinases as a prognostic factor for early postoperative period in patients with blunt splenic injuries.

Materials and methods. The study included 96 patients with blunt splenic injuries. Isolated lesions were detected in 47 patients (49 %), whereas 22 patients (22.9 %) presented with combined injuries. Study participants were divided into two groups. Group 1 included 47 patients with isolated injuries; Group 2 comprised 22 patients with combined trauma. We used the Abbreviated Injury Scale (AIS) to estimate the severity of injuries. We also assessed serum levels of tissue inhibitor of metalloproteinases 1 (TIMP-1) and matrix metalloproteinases 2, 7 and 9 (MMP-2, MMP-7, and MMP-9). Blood samples were collected from the peripheral vein on days 1, 3, 5, 7, 10, and 13 postoperatively.

Conclusion. Metalloproteinases play an important role in the development of complications after blunt splenic injuries. Changes in serum levels of TIMP-1, MMP-2, MMP-7, and MMP-9 are not similar and depend on the severity of lesions. Patients with AIS grade 3 isolated splenic injuries had the most significant changes, whereas individuals with AIS grade 1 injuries had minimal changes. Patients with grade 1 lesions demonstrated faster normalization of their laboratory markers (by day 5 postoperatively) compared to patients with grade 3 lesions, who had their laboratory parameters normalized only by day 13 postoperatively. Patients with combined and multiple injuries had changes in the parameters measured already one day postoperatively; no complete restoration was achieved by day 13.

1. Malkov I.S., Filippov V.A., Korobkov V.N. i dr. Diagnosticheskie aspekty zakrytyh povrezhdenij zhivota // Kazanskij medicinskij zhurnal. – 2016. – № 6 (97). – S. 892–897.

2. Maslyakov V.V., Avramenko A.V. Diagnosticheskaya cennost' osnovnyh klinicheskih simptomov pri zakrytyh travmah selezenki // Politravma. – 2013. – № 2. – S. 48–60.

3. Pikalo I.A. Povrezhdeniya selezenki v strukture sochetannoj letal'noj travmy u detej // Acta Biomedica Scientifica. – 2012. – № 4 (86). – S. 101–105.

4. Pelina N.A., Styazhkina S.N., Mal'chikov A.Ya. Dinamicheskaya ocenka ob"ema ostroj krovopoteri v rannem periode travmaticheskoj bolezni // Zdorov'e, demografiya, ekologiya finno-ugorskih narodov. – 2018. – № 4. – S. 57–59.

5. Charyshkin A.L., Demin V.P., Gafiullov M.R. Hirurgicheskoe lechenie bol'nyh s travmaticheskimi povrezhdeniyami selezenki // Ul'yanovskij mediko-biologicheskij vestnik. – 2015. – № 3. – S. 66–72.

6. Podkamenev V.V., Pikalo I.A. Kriterii vybora sposoba lecheniya detej s povrezhdeniyami selezenki // Detskaya hirurgiya. – 2015. – № 5 (18). – S. 23–27.

7. Podkamenev V.V., Pikalo I.A. Travma selezenki u detej (s kommentariem) // Hirurgiya. Zhurnal im. N.I. Pirogova. – 2015. – № 5. – S. 40–44.

8. Bastrygin A.V., Zhila N.G., Katkov A.N. Organosohranyayushchie metody lecheniya travmaticheskih razryvov selezenki // Dal'nevostochnyj medicinskij zhurnal. – 2010. – № 1. – S. 115–118.

9. Pankratov A.A., Izrailov R.E., Chudnyh S.M., Hat'kov I.E. Konservativnoe vedenie abdominal'noj travmy: celesoobraznost', effektivnost', bezopasnost' // Annaly hirurgii. – 2017. – № 22 (3). – S. 150–154.

10. Pereira B.M. Non-operative management of hepatic trauma and the interventional radiology: an update review // Indian J. Surg. – 2013. – № 75 (5). – Р. 339–345.

11. Gaspar B., Negoi I., Paun S. et al. Selective nonoperative management of abdominal injuries in polytrauma patients: a protocol only for experienced trauma centers // Maedica (Buchar). – 2014. – № 9 (2). – Р. 168–172.

12. Cirocchi R, Boselli C, Corsi A et al. Is non-operative management safe and effective for all splenic blunt trauma? // A systematic review. Crit. Care. – 2013. – № 17 (5). – Р. 185.

13. Inaba K., Branco B.C., Moe D. et al. Prospective evaluation of selective nonoperative management of torso gunshot wounds: when is it safe to discharge? // J. Trauma Acute Care. Surg. – 2012. – № 72 (4). – Р. 884–891.

14. Yarcev P.A., Gulyaev A.A., Pahomova G.V. i dr. Rol' videolaparoskopii v diagnostike i lechenii abdominal'noj travmy // Endoskopicheskaya hirurgiya. – 2008. – № 14 (2). – S. 28–31.

15. Yarmolinskaya M.I., Molotkov A.S., Denisova V.M. Matriksnye metaloproteinazy i ingibitory: klassifikaciya, mekhanizm dejstviya // Zhurnal akusherstva i zhenskih boleznej. – 2012. – № 1. – S. 113–125.